The effort, in Washington State, represents the most sweeping attempt yet to stem what some experts see as the excessive use of prescribed narcotics, and it is being closely watched by medical professionals elsewhere. Among other things, Washington would apparently become the first state that would require a doctor to refer patients on escalating doses of pain killers for evaluation if they were not improving.

Experts in pain treatment and drug abuse prevention say the growing use of long-acting pain killers like OxyContin, fentanyl and methadone has been a crucial factor in a nationwide epidemic of overdose deaths, largely from the abuse of such drugs.

In Washington, prescription drug overdoses have become an epidemic, replacing car accidents as the leading cause of injury-related death for people ages 35 to 54.

According to the state Department of Health, the rate of death from prescription overdoses increased 90 percent between 2003 and 2008.

The difficulty in preventing overdoses is compounded by the drugs’ dual nature; people use them both recreationally and legitimately for pain purposes. The state Legislature has directed a medical panel to come up with a set of practices that would be required in prescribing narcotics.